Suction Abortion Home Care

INTERIM UPDATE: This Practice Bulletin is updated as highlighted to reflect recent evidence regarding the use of mifepristone combined with misoprostol for medical management of early pregnancy loss. This Practice Bulletin also includes limited, focused updates to align with Practice Bulletin No. 181, Prevention of Rh D Alloimmunization .

This respondent’s uncertainty illuminates potential rationales and considerations employed among the minority of survey respondents who labelled stillbirth as definitely an abortion (5%) or maybe an abortion (8%).

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The process is “more private” than going to an abortion clinic, noted Elizabeth Nash, principal policy associate, state issues, at the Guttmacher Institute. “It feels much more like you are in control, and you don’t have to deal with protesters,” she added. Thirty-two states require physicians to prescribe the medications, while the remaining states allow advanced practice clinicians such as nurses and physician assistants to provide the pills. Another recent change has also helped make the medication more accessible. In December 2021, the FDA allowed medical professionals to prescribe the abortion oill via telemedicine visits. Currently, 31 states allow this. However, restrictions on telemedicine prescriptions remain, given that 19 states — mostly in the South and Midwest — ban medical professionals from prescribing the abortion pill via telehealth visits, according to the Kaiser Family Foundation.

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One of the questions before the justices is whether the FDA was right to lift the requirement that mifepristone be dispensed in person. That FDA decision “made it somewhat easier” for patients to access the drug, said Wendy Parmet, a Northeastern University law professor.

The following recommendations are based primarily on consensus and expert opinion (Level C):

We also found mixed patterns of agreement and disagreement in what counted as an abortion across the various vignettes. For eight of the 12 vignettes, at least 80% of survey participants agreed on whether the scenario was or was not considered an abortion (see Table 1 ). Four vignettes had less agreement among respondents, namely: self-managed abortion (failed abortion), miscarriage intervention at 12 weeks (medical miscarriage management), miscarriage intervention at 12 weeks (surgical miscarriage management), and miscarriage intervention at five weeks (medical miscarriage management).

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“I’d say ‘maybe [it’s an abortion], it depends’. It’s kind of hard for me on that one, because they know that the quality of life probably wouldn’t be there. I guess it’s not technically considered a miscarriage because they did get [an abortion as] their own choice” 105, in response to genetic testing card“I guess, I mean, maybe [it’s an abortion]. It depends on if you know you’re not able to take care of a severea sickly child I guess, then what choice do you have? Would you rather go all the way through, you know. I think it’s considered abortion only when you personally know you can take care of a child and you’re being selfish.” 103, in response to genetic testing card

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Discussion

That may be one of the lowest-risk and easiest options, experts say. Providers like Aid Access, a European telemedicine service that prescribes abortion pills to women in the U.S., has already seen an “enormous increase” in Americans looking to obtain the medications. The surge came in the wake of the leaked draft opinion that this month overturned Roe v. Wade. “So I would say, buckle up, women in the U.S. Just get your abortion pills in your medicine cabinet, so you have it in case you need it,” Dr. Rebecca Gomperts, who runs Aid Access, told CBS News last month. The process with Aid Access works via an online consultation, with the service then connecting the patient with a U.S.-based health care provider who can prescribe the pills. If they face restrictions within their home state, women may be connected with Gomperts herself, who can issue a prescription online and recommend an online pharmacy outside the U.S. to fill it. The medication requires about 10 to 20 days to arrive. “We expect to see more people ordering from Aid Access,” noted Allen. But, she added, there is still some risk in doing this. “If a law enforcement official had reason to believe someone was doing an illegal abortion, they could go after someone ordering the pills,” she said.

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The high court agreed Dec. 13 to hear appeals from the Biden administration and mifepristone’s brand-name manufacturer, Danco Laboratories LLC, over a ruling that would bar mail-order prescriptions and require in-person doctor visits.

First, ambiguity regarding the determination of when pregnancy begins contributed to respondents’ categorization of abortion. This ambiguity stemmed in part from the possibility of a person not knowing, or choosing not to find out, they were pregnant and the complications this circumstance could introduce for assessing whether the end of a pregnancy constitutes an abortion. Many respondents expressed doubt regarding the reliability of home pregnancy tests, mentioning the need to take multiple to confirm a result or requiring a clinical confirmation of pregnancy to consider a pregnancy “real.”

Cárdenas Peña, who lives in the Rio Grande Valley, works closely with migrant communities along the Texas-Mexico border to make sure they have the most up-to-date information on the availability of medication abortion and state laws on reproductive health care.

Medical Abortion (pregnancy termination with the Abortion Pill)

Now, another surge is likely “if there are inklings” the Supreme Court is going to rule in favor of anti-abortion medical groups challenging the Food and Drug Administration’s decisions to allow the abortion pill mifepristone to be prescribed via telehealth, said Abigail Aiken, the lead author of the JAMA study.

Four major themes emerged from our analysis of the qualitative results. The first theme, like the findings of the quantitative survey, centers on ambiguity regarding how to characterize pregnancy outcomes and when pregnancy begins, which in turn influences respondents’ perceptions of abortion. The second was that many respondents relied on their perception of the pregnant person’s intent to end the pregnancy when determining whether to classify an experience as an abortion. The third theme was the role of intervention in creating a boundary between miscarriage and abortion. Finally, some respondents’ lack of knowledge about potential pregnancy outcomes had an important influence on their notions of what constituted an abortion.

“There is a specific group of people that have access to the internet and see that information online and know exactly where to go to order the advance provision,” said Nancy Cárdenas Peña, campaign director of the Abortion On Our Own Terms campaign and former director for the National Latina Institute for Reproductive Justice.

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Further, although we utilized quota sampling that broadly mirrored the regional and racial/ethnic breakdown of the US based on the 2010 Census, our quantitative sample utilized an opt-in approach and was not fully nationally representative. Our qualitative sample was limited to people living within one of our two study states and should therefore not be considered representative of the US. This research was conducted prior to the Supreme Court’s Dobbs decision. The new decision and the wave of related state-level abortion bans, as well as the increased public discourse around abortion, may influence peoples’ pregnancy outcomes definitions. Thus, our findings refer to a particular point in time and revisiting these questions is essential, in order to understand how public discourse and legal challenges to abortion access may affect the blurred boundaries around abortion.

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References

The advance order of mifepristone as part of an abortion medication regimen is a legal gray area the FDA doesn’t explicitly address in its safety program for the drug, which has unusually high restrictions to begin with, health and legal experts note.

“No [not an abortion], because you don’t know if you were ever really pregnant. A lot of those little pregnancy tests are not accurate. Now, you could have changed it to say that she went to the doctor and confirmed [a pregnancy]. Like say she took a pregnancy test at home, and it’s a positive, and she got an appointment to see her doctor, and her doctor confirmed that she was pregnant. And then she ordered the pills. Then that’s something completely different.” 219, in response to self-managed abortion vignette

Research has shown that willingness to disclose an abortion experience is impacted by personal characteristics, and it is possible that conceptualizing abortion is similarly impacted. Our qualitative sample was limited to cisgender women, so our results should not be considered to speak for all women nor all people with the ability to become pregnant, but rather they are reflective of the people within our quantitative and qualitative samples. We expanded the eligibility criteria for the survey to include people assigned female at birth regardless of gender identity, in recognition that people with the capacity for pregnancy who are not woman-identified are often excluded from research about pregnancy and abortion. However, due to the small number of survey respondents indicating a gender identity other than cisgender woman, we were unable to further analyze survey data by gender identity. Future research should consider how diversifying the sample may impact responses and how people who were born male might categorize different pregnancy experiences; prior research suggests that men also perceive abortion as a stigmatized and sensitive behavior (Maddow-Zimet et al., 2021).

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